Telemedicine Solutions

Case Synopsis

Grand Hospital is non-profit health care organization located in Midwestern state. The Hospital holds 209 beds and provides a wide range of outpatient and inpatient services. The organization employs 1600 personnel among them 1250 full-time employees. The hospital has a 225 medical staff and an operating budget of over 130 million dollars (Wager & Glaser, 2009). Due to its quality services and excellent facilities, the organization has a “A” credit rating. However, the Hospital operates in a remarkably competitive environment given that there are over 100 hospitals surrounding it. Due to the increased health care needs of its patients, the hospital is currently been expanded and renovated. As a result, Grand hospital is striving to recruit physicians to help meet the health care needs of the developing population as well as to take the place of the retiring physicians. In this regard, the hospital leadership is exploring the potential application of telemedicine technologies to help in handling the organization’s requirements in radiology, critical care medicine and behavioral health.

Questions

1: What are the ways in which Grand’s early adoption of health care information system technologies might affect its adoption of telemedicine solutions)?

ICTs hold a considerable prospective to handle the challenges experienced by most hospitals in offering cost effective, high quality and accessible health care services. Particularly, Grand hospital needs to embrace creative approaches to improve physician coverage for radiology; critical care medicine and behavioral health can receive improvements through information and communication technologies. Notably, telemedicine utilizes ICTs to rise above geographical obstacles besides augmenting access to health care services. Telemedicine signifies utilization of ICT to enhance the outcome of patients through increasing medical information and care access. Telemedicine enhances provision of health care services where distance is a crucial aspect and works in interest of improving individuals and communities’ health. The main objective of telemedicine is to improve health upshots, overcome geographical barriers through use of ICT. Telemedicine reduces the variability of diagnoses besides enhancing clinical management and provision of health care services (Latifi, 2004). Telemedicine enhances sharing of healthcare expertise across regions.

The advances in computer and internet technologies creates new possibilities for patients and their doctors where doctors use computers to send live video, high-resolution images and sound between two distance locations. Doctors also examine long distance patients. Such strategies reduces cost and enhance efficiency through better retention and retrieval of records, management of chronic diseases and shared health professional staffing. Telemedicine allows transfer of medical information through internet, phones for purpose of examinations and more importantly, consulting.

In this regard, Grand Hospital early adoption of health care information system technologies may positively affect its adoption of telemedicine solutions. Among the major challenges that affect implementation of telemedicine solutions is communication. Communication is key to any successful telemedicine activity. Given that the hospital had already adopted health care information system in key areas such as laboratory, management, patient registration and EMRs, implementing telemedicine will be much easier (Latifi, 2004). The capability and availability of technology is another major challenge to telemedicine implementation. However, Grand Hospital has since 1995 utilized health care information systems. The availability of technology in the hospital and the ability to use it, maintain it and service it will make it much easier for the hospital to adopt telemedicine solutions. More so, having adopted health care information systems, Grand Hospital perhaps met all legal considerations, which include legislation governing privacy, access, liability needs, and this would be a positive effect towards adoption of telemedicine solutions. Technological challenges are other factors that prevent implementation of telemedicine solutions. This is because telemedicine systems are complex. Nevertheless, Grand Hospital introduced health care information systems since 1995 and the professional knows how to handle malfunction thereby preventing hardware or software failure.

2. What do you see as the most likely barriers to the success of telemedicine in the areas of radiology, behavioral health and intensive care? Which of these areas do you think would be the easiest into telemedicine and which is hardest?

Radiology service is known for its considerable use of telemedicine where scores of images are read. Digital images are distributed to experts through broadband networks (Gullo, 2011). Telemedicine entails applications using two-way email, video, phones and other types of telecommunication technology. Telemedicine applications are in hospital operations, home health agencies and specialty departments. With technology advancements, the film-based imaging embraces digital information that can be stored in computer disk, CD or DVDs. This allows digital data transfer and storage. The images are disturbed to different departments for image diagnosis and manipulation. The images can be provided online or offline.

Notably, radiology information system helps in integrating patients’ profile on a single area to form A DICOM that reduces workload. Presently, available images in Nuclear Medicine are of low-resolution hence reduced storage problems. However, the diagnostic workstation where radiologists report should hold a high-resolution display screens. Not less than 2K screens are needed and after reporting, the images should be stored in less compression format in the hospitals server. The compression format should be 3:1 and a format higher than that can lead to loss of information consequently leading to misinterpretation that would result to false negative or positive diagnosis (Gullo, 2011). Plain X-rays are the highest resolution images hence requiring huge data volumes. The compression of the data triggers loss of information hence adequate care needed to avoid information loss. The challenges for Grand Hospital implementation of telemedicine in radiology include the need for high-resolution display screens and storage care where images should be carefully stored to avoid misinterpretation and loss of crucial information.

Telemedicine in behavioral health is cost-effective as it enhances accessibility of services . Behavioral telemedicine offers required solutions to obstacles for needed treatment. It entails video conferencing between specialist experts and doctors for treatment, follow up and consultation. Notably, mental health involves examination, prevention and treatment of mental health illness. However, telepyschiatry is affected by legal liability that hinders the success of telemedicine in behavioral health given confidentiality, security and private issues. Security, confidentiality and privacy are legal and ethical considerations that present scores of implications to patients and therapists engaging in telepyschiatry.

Care and monitoring of patients in critical care units has evolved within the framework of the model in which a specialist is present in the same place as the patient (Gullo, 2011). The specialist must be physically near the patient not only to conduct medical acts and processes but also to monitor the patient’s evolution, see medical images and make suitable decisions. A physician must be physically present to conduct procedures such as placing central venous line or intubating a patient, hence the rest of physician’s responsibilities cannot be fulfilled from a remote location (Gullo, 2011). Therefore, with respect to Intensive Care, physicians are usually reluctant to delegate complete accountability to telemedicine team. The major obstacle to the success of execution of ICU telemedicine is the recognition of the new technology by healthcare workers and administration. This makes telemedicine in intensive unit the hardest, because physician should always be physically present. On the other telemedicine in mental health is easier given that only legal considerations can hinder it. Teleradiology though very crucial requires much care particularly in storage of data contained in the images.

3. If you were charged by Grand to bring telemedicine to the facility within 18 months, what are the first steps you would take? Whom would you involve in the planning process?

To develop the suitable telemedicine solutions effectively, a system approach will be needed to guarantee adequate design, build up, integration and execution. This will involve seven steps, which include champion identification, needs assessment, objectives and goals, definition of requirements, assessing available technology, execution and finally evaluation and validation (Latifi, 2004). I will require a cheerleader or a champion. This must be someone passionate about telemedicine and its abilities with respect to Grand hospital. Secondly, I will review the circumstances where telemedicine implementation will take place (Latifi, 2004). I will set the objectives and goals through providing a roadmap of why, how and what telemedicine will be implemented. Checking on the availability of technology is paramount as well as how to use the available technology and maintain it. This will be followed by implementation procedure and its operation will be tested through evaluation and validation in order to ensure its utility. The hospitals executive committee and the leadership will be involved as they will help in financing the required project. More importantly, a champion or cheerleader is crucial to foresee the implementation process.

References

Gullo, A. (2011). Anesthesia, pharmacology, intensive care and emergency A.P.I.C.E: Processing of the 23rd annual meeting-International symposium on critical care medicine, Volume 23. New York: Springer.

Latifi, R. (2004). Establishing telemedicine in developing countries: From inception to implementation. London: IOS Press.

Wager, K., & Glaser, J. (2009). Health care information systems: A practical approach for health care management. London: John Wiley & Sons.